A brief HL7 Version 3 Introduction for CIMI
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Transcript of A brief HL7 Version 3 Introduction for CIMI
8/15/2012 C. 2012 HL7 Int'l and Shafarman Consulting, Inc.
A brief HL7 Version 3 Introduction
for CIMIMark ShafarmanPast Chair HL7
with additional HL7 “roles” of past co-chair International Council past co-chair Control/Query TC past member Architectural
Review Board co-chair Templates WG
CEO & Chief Information Architect Shafarman Consulting, [email protected] +1 510 593 3483
C. 2012 HL7 Int'l and Shafarman Consulting, Inc. 28/15/2012
Agenda:• Brief overview of the HL7 v 3 Reference Information
Model– The HL7 RIM – model of clinical information content
• Some examples from the 2011 Normative edition• Discussion/Questions
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Core concepts of HL7 v3 RIM
• The “Act” class and its specializations represent every action of interest in health care.
• Specifically –“an action of interest that has happened, can happen, is happening, is intended to happen, or is requested/demanded to happen. An act is an intentional action in the business domain of HL7. Healthcare (and any profession or business) is constituted of intentional actions. An HL7 Act instance is a record of such an intentional action.
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Core concepts of RIM• Every happening is an Act
– Procedures, observations, medications, supply, registration, etc.
• Acts are related through an Act_relationship– composition, preconditions, revisions, support, etc.
• Participation defines the context for an Act– author, performer, subject, location, etc.
• The participants are Roles– patient, provider, practitioner, specimen, healthcare facility
etc.
• Roles are played by Entities– persons, organizations, material, places, devices, etc.
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Referral
authorized_visits_qty : REAL
Observation
value : ANYinterpretation_cd : SET<CE>method_cd : SET<CE>target_site_cd : SET<CD>derivation_expr : ST
Substance_administration
route_cd : CEapproach_site_cd : SET<CD>dose_qty : IVL<PQ>rate_qty : IVL<PQ>dose_check_qty : SET<RTO>max_dose_qty : SET<RTO>potency_qty : PQsubstitution_cd : CE
Procedure
method_cd : SET<CE>approach_site_cd : SET<CD>target_site_cd : SET<CD>
Supply
qty : PQexpected_use_time : IVL<TS>
Diet
energy_qty : PQcarbohydrate_qty : PQ
Clinical_document
set_id : IIversion_nbr : INTcompletion_cd : CEstorage_cd : CEcopy_time : TS
Container
capacity_qty : PQheight_qty : PQdiameter_qty : PQcap_type_cd : CEseparator_type_cd : CEbarrier_delta_qty : PQbottom_delta_qty : PQ
Access
approach_site_cd : CDtarget_site_cd : CDgauge_qty : PQ
Device
manufacturer_model_nm : STsoftware_nm : STlocal_remote_control_state_cd : CEalert_level_cd : CElast_calibration_time : TS
Employee
job_cd : CEjob_title_nm : STjob_class_cd : CEsalary_type_cd : CEsalary_qty : MOhazard_exposure_txt : EDprotective_equipment_txt : ED
Living_subject
administrative_gender_cd : CEbirth_time : TSdeceased_ind : BLdeceased_time : TSmultiple_birth_ind : BLbirth_order_nbr : INTorgan_donor_ind : BL
Material
form_cd : CE
Assigned_entity
position_cd : CEprimary_care_ind : BL
Certified_entity
recertification_time : TS
Place
mobile_ind : BLaddr : ADdirections_txt : EDposition_txt : EDgps_txt : ST
Manufactured_material
lot_nm : STexpiration_time : TSstability_time : IVL<TS>
Non_Person_living_subject
taxonomic_classification_cd : CEbreed_cd : CEstrain_txt : EDgender_status_cd : CEeuthanasia_ind : BL
Patient
confidentiality_cd : CEvery_important_person_cd : CE
Organization
addr : BAG<AD>standard_industry_class_cd : CE
Account
nm : STcurrency_cd : CEinterest_rate_qty : RTO<MO,PQ>allowed_balance_qty : IVL<MO>
Financial_act
net_amt : MO
Person
addr : BAG<AD>marital_status_cd : CEeducation_level_cd : CEambulatory_status_cd : CEdisability_cd : CEliving_arrangement_cd : CEreligious_affiliation_cd : CEspecial_accommodation_cd : SET<CE>race_cd : SET<CE>ethnic_group_cd : SET<CE>
Working_list
ownership_level_cd : CE
Public_health_case
detection_method_cd : CEtransmission_mode_cd : CEdisease_imported_cd : CE
Patient_encounter
acuity_level_cd : CEadmission_source_cd : CEbirth_encounter_ind : BLdischarge_disposition_cd : CElength_of_stay_qty : PQpre_admit_test_ind : BLreferral_source_cd : CEspecial_courtesies_cd : SET<CE>urgency_cd : CEvaluables_desc : EDvaluables_location_desc : ED
Schedulable_resource
slot_size_increment_qty : PQ
Acts (Financial)
Acts (Clinical)
Infrastructure (Structured documents)
HEALTH LEVEL 7 REFERENCE INFORMATION MODEL VERSION 1.15 (RIM_0115)
Version reflects RIM changes through Harmonization on 03/07/2002 that were approved for implementation following the release of the second committee-level ballot of Version 3.
Billboard produced by:Rochester Outdoor Advertising
Roles
Guarantor
credit_rating_cd : CE
Diagnostic_image
subject_orientation_cd : CE
Imaging_modality
pixel_intensity_relationship_cd : CEspacial_resolution_qty : PQpixel_padding_qty : PQ
Query_ack
query_response_cd : CSmessage_query_cd : CEresult_total_qty : INTresult_current_qty : INTresult_remaining_qty : INT
Query_continuation
continuation_qty : INTstart_result_nbr : INT
Table
rules : CScellspacing : STcellpadding : STsummary : STwidth : STborder : INTframe : CS
Table_structure
halign : CSchar : STcharoff : STvalign : CSlocal_id : ST
Table_column_structure
span : INTwidth : ST
Table_cell
rowspan : INTcolspan : INTabbr : STaxis : STheaders : SET<ED>scope : CS
Local_attr
name : STvalue : ST
Local_markup
ignore_cd : CSdescriptor : STrender : ST
Link_html
title : STname : SThref : EDrel : SET<CE>rev : SET<CE>
Context_structure
local_id : ST
Infrastructure (Structured documents)
Infrastructure (Message control)
Enitites
Message Control
Financial_transaction
credit_exchange_rate_qty : REALdebit_exchange_rate_qty : REALinterest_rate_qty : RTO
Invoice_element
modifier_cd : CEunit_qty : PQunit_price_amt : RTO<MO,PQ>factor_nbr : REALpoints_nbr : REALcoverage_source_cd : CEnotify_subject_ind : BL
Financial_contract
payment_terms_cd : CE
Role_heirEntity_heir
Sort_control
element_nm : STsequence_nbr : INTdirection_cd : CS
Query_spec
execution_and_delivery_time : TSinitial_qty : INTinitial_qty_cd : CEmessage_query_cd : CEmodify_cd : CSresponse_modality_cd : CSresponse_priority_cd : CSresponse_element_group_id : SET<II>
0..n 1
is_for
0..n
has
1
Relational_expression
element_nm : STvalue : STrelational_operator_cd : CS
Query_by_selection Selection_expression0..n1is_for
0..n
has_ex pression
1
Logical_expression
relational_conjunction_cd : CS
1
0..n
has_left_side1
is_lhs_for0..n
1
0..n
has_right_side
1
is_rhs_for0..n
Query_by_parameter
Parameter_list
Parameter
nm : STid : II 0..n 0...
is_parameter_of0..n
has
0...
0..1
0..n
may_contain 0..1
is_part_of
0..n
Parameter_item
value : ANYsemantics_txt : ST
Device_task
parameter_value : LIST<ANY>
Acknowledgement
type_cd : CSnote_txt : EDerror_detail_cd : CEexpected_sequence_nbr : INT
Message
accept_ack_cd : CSapplication_ack_cd : CSattachment_txt : EDinteraction_id : IIprocessing_cd : CSprocessing_mode_cd : CSprofile_id : SET<II>sequence_nbr : INTversion_id : ST
0..*
1
acknowledges0..*
is_acknowledged_by1
0..1
1
occurs_wi th0..1
has 1
Query_event
query_id : II
Control_event
structure_type_id : IIresponse_cd : CS
0..1
0..n
is_communicated_as
0..1
has_payload
0..n
0..1
1
occurs_with
0..1
may_have 1
Act_relationship
type_cd : CSinversion_ind : BLcontext_control_cd : CSsequence_nbr : INTpriority_nbr : INTpause_qty : PQcheckpoint_cd : CSsplit_cd : CSjoin_cd : CSnegation_ind : BLconjunction_cd : CS
Act_context
level_cd : CE
Act
class_cd : CSmood_cd : CSid : SET<II>cd : CDnegation_ind : BLtxt : EDstatus_cd : SET<CS>effective_time : GTSactivity_time : GTSavailability_time : TSpriority_cd : SET<CE>confidentiality_cd : SET<CE>repeat_nbr : IVL<INT>interruptible_ind : BLcontext_lock_ind : BLindependent_ind : BLreason_cd : SET<CE>language_cd : CE
0..n1
has_target
0..n
is_target_for
1
0..n1
has_source
0..n
is_source_for
1
1..*
0..*
originates_in_context_of
1..*
provides_context_for
0..*
Participation
type_cd : CSfunction_cd : CDcontext_control_cd : CSsequence_nbr : INTnote_txt : EDtime : IVL<TS>mode_cd : CEawareness_cd : CEsignature_cd : CSsignature_txt : ED
0..n 1
for
0..n
has
1
Role_link
type_cd : CSeffective_time : IVL<TS>
Role
class_cd : CSid : SET<II>cd : CEnegation_ind : BLaddr : BAG<AD>telecom : BAG<TEL>status_cd : SET<CS>effective_time : IVL<TS>certificate_txt : EDqty : RTOposition_nbr : LIST<INT>
0..n1
has_as_participant
0..n
participates_in
1
0..n1
has_source
0..n
is_source_for
1
0..n1
has_target
0..n
is_target_for
1
Language_communication
language_cd : CEmode_cd : CEproficiency_level_cd : CEpreference_ind : BL
Attention_line
key_word_txt : STvalue : ST
Batch
nm : STreference_control_id : IIbatch_total_nbr : SET<INT>batch_comment : SET<ST>transmission_qty : INT
Entity
class_cd : CSdeterminer_cd : CSid : SET<II>cd : CEqty : SET<PQ>nm : BAG<EN>desc : EDstatus_cd : SET<CS>existence_time : IVL<TS>telecom : BAG<TEL>risk_cd : CEhandling_cd : CEimportance_status_txt : ED
0..n0..1
is_played_by
0..n
plays
0..1
0..n0..1
is_scoped_by
0..n
scopes
0..1
10..n
communicates_with
1
used_by
0..n
Transmission
creation_time : TSid : IIsecurity_txt : ST
0..n1
can_accompany
0..n
can_include
1
0..1
0..n
contains 0..1
is_contained_by
0..n
Communication_function
type_cd : CStelecom : TEL
1..n
0..*
serves
1..n
served_by
0..*
1..*0..*
executed_by
1..*
executes
0..*
Managed_participation
id : SET<II>status_cd : SET<CS>
Act_heir
RIM Core Classes
Entity Role
Participation
FinancialActs
Living SubjectLiving SubjectPersonPersonOrganizationOrganizationMaterialMaterialPlacePlace......
PatientPatientEmployeeEmployeeAssigned EntityAssigned EntityCertified EntityCertified EntityGuarantorGuarantor......
PerformerPerformerAuthorAuthorWitnessWitnessSubjectSubjectDestinationDestination......
ObservationObservationProcedureProcedureSupplySupplySubstance AdmSubstance Adm
Adminis-trativeActs
ClinicalActs
Account,Account,Invoice Invoice Element,Element,Financial Financial Contract,Contract,Financial Financial
TransactionTransaction
PatientPatientEncounter, Encounter,
RegistryRegistry
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How does HL7 manage this abstraction?• In the first HL7 RIM models, each concept had a
visible (physical) class or association to represent it• In current RIM:
– We only include a class when it adds new attributes and associations
– for the rest, use coded “structural” attributes – • ‘class’ or ‘type’ codes• ‘mood’ or ‘determiner’ codes
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• Why are these named structural attributes? – because they use codes to represent concepts that
would previously have been part of the model structure
– Each structural attribute has a specific HL7 concept domain with an HL7-defined ‘fixed’ value set.
• In an ontological context, the formal code sets for the structural attributes form the RIM metadata ontology.
• Note that this now has a parallel in SNOMED CT, which also has a formal metadata ontology.
Structural metadata
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• But it also has the ability to have formal healthcare ontologies bound to specific attributes (linked to Intentional model world).
• For SNOMED CT there is the Terminfo implementation guide.
• LOINC is another standard terminology/ontology that is commonly bound to RIM models.
• These two aspects support applying description logic to the analysis of RIM model instances.
The RIM is an extensional model
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Entity
classCode CScode : CDdeterminerCode : CSstatusCode : CS
Role
classCode : CScode : CEeffectiveTime : IVL<TS>
Participation
typeCode : CStime : IVL<TS>
Act
classCode : CScode : CDmoodCode : CSstatusCode : CSactivityTime : GTS
1
0..* 1
0..*
1
0..*
RIM Core Classes & Attributes
1
0..*
plays
scopes
Six kinds of attributes define semantics of each “backbone class: typeCode(classCode), code, time, mood(determiner), status, id
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Entity
classCode CScode : CDdeterminerCode : CSstatusCode : CS
Role
classCode : CScode : CEeffectiveTime : IVL<TS>
Participation
typeCode : CStime : IVL<TS>
Act
classCode : CScode : CDmoodCode : CSstatusCode : CSactivityTime : GTS
1
0..* 1
0..*
1
0..*
RIM Core Structural Attribute Value Sets
Entity.classCode
• Living SubjectLiving Subject• PersonPerson• OrganizationOrganization• MaterialMaterial• PlacePlace• ......
Role.classCode
• PatientPatient• EmployeeEmployee• Assigned EntityAssigned Entity• Certified EntityCertified Entity• GuarantorGuarantor• ......
Participation.typeCode
• PerformerPerformer• AuthorAuthor• WitnessWitness• SubjectSubject• DestinationDestination• ......
Act.moodCode
• DefinitionDefinition• IntentIntent• RequestRequest• EventEvent• CriterionCriterion• ......
Act. classCode
• ObservationObservation• ProcedureProcedure• SupplySupply• Substance AdmSubstance Adm• FinancialFinancial• ……
Entity.determinerCode
• KindKind• InstanceInstance• QualifiedQualified
GroupGroup
1
0..*
plays
validates
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E.g. Value Set for moodCode (a Structural Attribute)
Wbc Order (Request) to occur on 12/12/07@2pmPST
Wbc Observation of ‘xxx’ made on 10/1/07@1pmPST
Wbc goal of specific value of ‘yyy’ to be attained by 11/1/07
3 instances of Act, specialization OBServation, act.code attribute = “wbc” (actually = the corresponding LOINC code for White Blood Count)
moodCode=RQO
effectiveTime =“12/12/07@ 2pm PST”
(No Value Attribute inthis model)
moodCode=Goal
effectiveTime =“11/1/07”
(Goal)Value=“yyy”
moodCode=EVN
effectiveTime =“10/1/07@ 1pm PST”
(Observation)Value=“xxx”
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Entity
classCode CScode : CDdeterminerCode : CSstatusCode : CS
Role
classCode : CScode : CEeffectiveTime : IVL<TS>
Participation
typeCode : CStime : IVL<TS>
Act
classCode : CScode : CDmoodCode : CSstatusCode : CSactivityTime : GTS
1
0..* 1
0..*
1
0..*
Person (in role of Patient) participates as subject of an Observation (lab test, performed)
Entity.classCode
• • PersonPerson•
Role.classCode
• PatientPatient•
Participation.typeCode
• • • • SubjectSubject•
Act.moodCode
• • • • EventEvent• • ......
Act. classCode
• ObservationObservation•
Entity.determinerCode
• • InstanceInstance•
1
0..*
plays
validates
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Entity
classCode CScode : CDdeterminerCode : CSstatusCode : CS
Role
classCode : CScode : CEeffectiveTime : IVL<TS>
Participation
typeCode : CStime : IVL<TS>
Act
classCode : CScode : CDmoodCode : CSstatusCode : CSactivityTime : GTS
1
0..* 1
0..*
1
0..*
Person in role of physician <assigned entity> participates as author of an Observation (lab test order)
Entity.classCode
• Living SubjectLiving Subject• PersonPerson• OrganizationOrganization• MaterialMaterial• PlacePlace• ......
Role.classCode
• PatientPatient• EmployeeEmployee• Assigned EntityAssigned Entity• Certified EntityCertified Entity• GuarantorGuarantor• ......
Participation.typeCode
• PerformerPerformer• AuthorAuthor• WitnessWitness• SubjectSubject• DestinationDestination• ......
Act.moodCode
• DefinitionDefinition• IntentIntent• RequestRequest• EventEvent• CriterionCriterion• ......
Act. classCode
• ObservationObservation• ProcedureProcedure• SupplySupply• Substance AdmSubstance Adm• FinancialFinancial• ……
Entity.determinerCode
• KindKind• InstanceInstance• QualifiedQualified
GroupGroup
1
0..*
plays
validates
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Entity
classCode CScode : CDdeterminerCode : CSstatusCode : CS
Role
classCode : CScode : CEeffectiveTime : IVL<TS>
Participation
typeCode : CStime : IVL<TS>
Act
classCode : CScode : CDmoodCode : CSstatusCode : CSactivityTime : GTS
1
0..*1
0..*
1
0..*
A single act may have multiple participations
1
0..*
plays
Participation
typeCode : CStime : IVL<TS>
Role
classCode : CScode : CEeffectiveTime : IVL<TS>
Entity
classCode CScode : CDdeterminerCode : CSstatusCode : CS
1
1
scopes
plays
1
0..*
scopes
0..*
0..*
0..*
1
Person (in role of Patient) participates as subject of an Observation Order (lab test order)
Person in role of physician <assigned entity> participatesas author of an Observation (lab test order)
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Entity
classCode CScode : CDdeterminerCode : CSstatusCode : CS
Role
classCode : CScode : CEeffectiveTime : IVL<TS>
Participation
typeCode : CStime : IVL<TS>
Act
classCode : CScode : CDmoodCode : CSstatusCode : CSactivityTime : GTS
1
0..* 1
0..*
1
0..*
RIM Core Classes & Attributes
1
0..*
plays
scopes
• Six kinds of attributes define semantics of each “backbone class: typeCode(classCode), code, time, mood(determiner), status, id
• We have shown parts of some of the basic HL7 defined value sets for structural attributes, but entity.code, role.code, and
act.code are key attributes that use non-HL7 standard terminologies.• E.g. for act.code, LOINC and SNOMED-CT, are key value sets for observation and procedure concept domains.
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Two other critical RIM classes
• ActRelationship: creates formal relationships between acts, such as:– E.g. (structural) — Comp, component,
• As in a CBC observation (complete blood count) has component acts RBC (red blood cell count); WBC, white blood cell count; etc.
– E.g. (causal) — RSON, reason; CIND: contraindication; PRCN, precondition
– And several types of qualifiers and modifiers
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• RoleLink: A <rarely used> connection between two roles expressing a dependency between those roles and permitting the authorization or nullification of a dependent role based on status changes in its causal or directing role.– E.g. A role of assignment or agency depends on another role of
employment, such that when the employment role is terminated, the assignments are terminated as well.
Two other critical RIM classes
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RIMBAA note
The previous diagram, the “RIM on (just) one page.”Is the basic SQL design for RIMBAA systems.
But this requires (see below) using the structural variables to navigate the RIM models. (another presentation)
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V3 and physical data• Act, specialization “observation”
– Act.class=“OBS”– Act.code=<code for observation type>
• E.g. LOINC, SNOMED, etc. (per HL7 “realm”)
– Act.mood • Event for actual measurement• Request for “order/request” for measurement
– Act.ID=“instance identifier” for the measurement– Act.value= the physical observation
• DataType of act.value is, as in v 2.x, allowed to be any appropriate datatype (usually PQ, physical quantity; may be Set(PQ).
– Act.effectiveTime= “physiologically relevant time of observation” (e.g. “when in the patient’s life the observation was made)
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V3 and physical data
• Act/observation continued:– interpretationCode (SET<CE>)
• One or more codes specifying a rough qualitative interpretation of the observation, such as "normal", "abnormal", "below normal", "change up", "resistant", "susceptible", etc
• Act/observation continued:– methodCode (SET<CE>)
• Examples: Blood pressure measurement method: arterial puncture vs. sphygmomanometer (Riva-Rocci), sitting vs. supine position, etc.
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V3 and physical data
• Act/observation continued:– targetSiteCode (SET<CD>)
• A code specifying detail about the anatomical site or system that is the focus of the observation if this information is not already implied by the observation definition or Act.code.
• Constraints: The targetSiteCode value, if specified, must not conflict with what is implied about the target site or system from the observation definition and the Act.code.
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Summary
• We have briefly reviewed– an introduction to the RIM
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…Further Discussion…
…Other topics?...
…Questions?...